Data Contribution FormPlease complete all applicable sections of the online form below.Alternatively, the form can be downloaded from Information- Documents section of the website. Please return the completed forms to viccta@glasgow.ac.uk.

Clinical datasets will be lodged with the Robertson Centre for Biostatistics, University of Glasgow on behalf of VICCTA.

Section 2.0 Contribution Procedure Please provide contact details for the Principal Investigator(s) who will represent the trial on the VICCTA Steering Committee:

Section 2.1

Name

Address

Phone Number

Email Address

Section 2.1

Name

Address

Phone Number

Email Address

Please detail the inclusion of relevant documents for your clinical dataset in the check-box below and email a copy of these documents along with the dataset, to viccta@glasgow.ac.uk in a password protected folder. If an electronic copy is unavailable, then a CD can be courier mailed to:

Source(s) used to create the data collection, relationships between the data collection and the source(s), coding systems used, algorithms defined

Lists of files names

Variable names

Variable Description and Format

Categorical variable decodes, if a coding system is used then this data should be included.

Number of records in each file provided.

Relationships between files

Key identifier fields, such as subject number.

Format of the data, including delimiters used.

Section 3 Memorandum of Understanding

Clinical data will be stored by the Robertson Centre for Biostatistics, University of Glasgow, on behalf of VICCTA.

Clinical datasets should be accompanied by an annotated Case Report Form which explains variable names and codes.

Contribution of trial data to VICCTA entitles the principal investigator to a seat on the VICCTA Steering Committee. In this role they will be responsible for the review of proposed projects using the VICCTA resource and the approval of subsequent manuscripts for publication.

All abstracts or manuscripts will be reviewed by the Steering Committee prior to submission for publication. This applies to both national and international publications.

Analyses will not be undertaken and/or published or reported to an outside group without the knowledge and approval of the VICCTA Steering Committee.

Access to individual trials will not be granted without prior consent by the PI for the named trial/ registry.

Inadvertent un-blinding of any individual study in an internal report may not be perpetuated in any subsequent publication.

Any publication arising through VICCTA analyses will be accompanied by an acknowledgement that the study is a part of the VICCTA Collaboration.

Contributing trialists whose anonymised data are used in analyses will be offered co-authorship of subsequent manuscripts, provided that criteria for co-authorship are met.

I hereby acknowledge that I have read and understood the terms and conditions and consent to the contribution of the proposed trial/ registry to VICCTA.

Agree to Terms and Conditions*

Attached ZIP file containing all required documents

Name*

Date

Address*

Phone Number*

Email Address*

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